Peak Partnered: This article was developed in proud partnership with Resensation by Axogen. Resensation and The Breasties are joining forces to raise awareness of post-mastectomy sensation loss and options for nerve reconstruction.
You know how they say you don’t know what you’ve got until it’s gone?
It’s a realization that’s all too real for many people who’ve had a mastectomy to treat or reduce the risk of breast cancer and experience a loss of sensation in their chest as a result.
When the nerves in the chest are cut during surgery, the range of everyday sensations you have come to know, from pleasure to pain, may change, if not vanish entirely. Long believed to be an accepted side effect of life-saving and risk-reducing mastectomies, this loss of sensation was something many people just had to live with.
Fortunately, surgical and technological advances have flipped the script. The availability of nerve grafts can facilitate surgical procedures, like Resensation, that help your nerves grow back so that you can regain sensation in your chest.
The Breastie’s Guide to Resensation is here to give you an overview of how and why sensation is impacted after a mastectomy, how nerve reconstruction works, and tools to decide if it may be right for you.
What is Sensation and Why Does it Matter?
Sensation refers to the physical feeling or perception of something that comes in contact with the body and is enabled by the peripheral nervous system.
Nerves run throughout the body and communicate messages to the brain that provide information on your body and environment. When nerves are cut or damaged, they can no longer transmit signals. No signals means no sensation.
Types of sensations that people experience day-to-day include feeling warm water in the shower, the sun on your skin while at the beach and the embrace of a hug or touch from a loved one.
But sensation also keeps us safe. It’s a first line of defense against injuries such as burns or cuts. Changes in sensation can significantly impact your quality of life and how you interact with and feel connected to your own body.
Chronic pain and nerve injuries go hand-in-hand. Because of the way nerves are impacted during a mastectomy, some people report a range of side effects from persistent pins-and-needles tingling to burning or stabbing-like pain.
For many, sensation and sensuality are also closely linked, with 90 percent of breast cancer patients reporting that their breasts play an important role in intimacy.
If you are worried about losing sensation in your chest following a mastectomy, it is important to understand that this is not a vain concern: sensation impacts quality of life in many ways.
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How are Nerves Impacted During a Mastectomy
Think of your nerves as power cords that send electricity from a wall outlet to an appliance. If the cord is cut, the appliance won’t be able to turn on.
It makes sense that situations where tissue is cut and removed, like the surgeries that remove breast tissue to treat or reduce the risk of breast cancer, can also cut and damage your nerves.
Specifically, three significant branches of intercostal nerves (ICNs) run from the spine, along the ribs, to supply sensation to the skin, breast, and nipple: ICN 3, 4, and 5. These nerves travel to your chest and branch through the breast and fat tissue similar to roots of a tree. Most nerve endings are in the nipple and areola.
Because the purpose of a mastectomy is to remove the breast tissue, with oncological safety as the number one priority, the nerves embedded in that tissue will have to be removed, no matter what.
Fortunately, peripheral nerves can grow back through a process called nerve regeneration or neuroregeneration. However, this happens slowly and isn’t guaranteed. Nerves that were completely severed, like those cut and removed during a mastectomy, may not recover at all.
Though some people may regain partial sensation on their own, others never do. Even the most experienced surgeons can’t predict how your body may recover compared to others who have undergone the same procedure.
What is Resensation?
Resensation, also known as breast nerve reconstruction, breast nerve repair, and breast neurotization, is a surgical technique that uses a nerve allograft to bridge the gap between the cut nerve from the chest wall to a nerve ending in the breast, nipple, or areola to improve sensation recovery.
A nerve allograft is donated nerve tissue that is processed and sterilized and can be used to bridge a gap between two nerve ends. Trained plastic surgeons will use microsurgical techniques to reconnect the cut nerve ends with the use of nerve connectors.
The nerve allograft provides the structure that enables the nerve to heal and grow, restoring its lost function, which is how you may be able to regain sensation.
While nerve reconstruction marks significant progress in the possibility of regaining sensation, it’s important to know that the level of sensation you regain will likely not be the same as before surgery and cannot be guaranteed.
Your Team Players
In most cases, your surgical team will consist of two key players: a breast surgeon and a plastic surgeon. Your breast surgeon will oversee the removal of breast tissue while your plastic surgeon will tap in to take charge of your breast reconstruction and nerve repair.
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It’s important to know that not all plastic surgeons are trained in this technique. Nerve reconstruction requires a plastic surgeon to have expertise in microsurgery.
Microsurgery is exactly what it sounds like: the use of a microscope or loupe magnification and specialized equipment to precisely operate on very small structures, like blood vessels and nerves. Microsurgical techniques are also used for autologous breast reconstruction, like DIEP flaps.
Even though your breast surgeon won’t be the one completing the nerve reconstruction, it’s important that they work closely with your plastic surgeon to set them—and your nerves—up for success.
During the mastectomy, your breast surgeon can help determine which nerve could be the best for your plastic surgeon to reconstruct. They will do their best to preserve as much length of that nerve as is safe and appropriate.
Once the mastectomy is complete and your breast tissue has been removed, your plastic surgeon will complete the nerve reconstruction with a nerve allograft while also making all final breast reconstruction adjustments to complete the operation. Resensation can be performed during implant, autologous flap or aesthetic flat closure surgery.
If you are still building out your surgical team, the Resensation surgeon locator tool is a helpful starting point for finding a plastic surgeon who can perform nerve reconstruction. Once you’ve established your plastic surgeon, they can provide you with names of partnering breast surgeons for the mastectomy and nerve identification portion of your procedure.
While many will choose to undergo Resensation at the time of their mastectomy, it is still possible to pursue nerve reconstruction months or even years later, depending on the situation. Speaking with an experienced Resensation surgeon is the best route to understand your options.
The Recovery Process
Recovery following a mastectomy and breast reconstruction with nerve repair will look different for everyone, depending heavily on the type of surgery you’ve had, whether you’ve had other cancer treatments, and additional factors like your age or anatomy.
It’s normal for sensation to return slowly after nerve reconstruction. You can expect to start noticing the signs of sensation starting to return several months after your surgery. At first, these may feel like small shocks, zaps, tingling, or itchiness.
It can take two years or more for your nerves to regrow and sensation to return. It is normal not to feel completely back to your pre-surgery self. Your sensation will likely be different from what it was before.
Sensory Retraining
One way that you can support your recovery from nerve reconstruction is through sensory retraining, a type of physical therapy meant to encourage neuroplasticity as your nerves heal. The practice draws on expertise of rehabilitation therapists and physicians specializing in nerve-related traumas.
The process is easy to learn and perform right in the comfort of your home every day.
Sensory retraining can help retrain your brain and body to connect sensory responses with sensory stimuli through consistent practice.
The idea is that as you watch yourself touch the affected area, your brain will be working to rewire its response to the nerves that are being stimulated.
Is Nerve Reconstruction Right for You?
Regardless of the type of breast reconstruction, nerve allografts and Resensation have made it possible for more people to regain sensation after their mastectomies.
While it varies case-by-case, a surgeon experienced in nerve reconstruction is typically able to find nerves during implant, autologous, or aesthetic flat closure procedures.
But even though you may be a candidate, there are many other factors to consider when deciding if nerve reconstruction is right for you.
Questions for Your Team
To understand more about what nerve reconstruction might look like for you, use the following questions as conversation starters with your medical team.
Like with any medical procedure, it’s important to feel confident in your decision and to trust that you and your team are on the same page about expected outcomes.
For your breast surgeon while planning your mastectomy:
- What is your experience with nerve identification during mastectomy?
- Which plastic surgeon(s) do you partner with who have experience performing Resensation?
- How do you collaborate with the plastic surgeon during the operation to identify potential nerves for repair?
- Based on my situation, am I a candidate for Resensation at the time of my mastectomy?
For your plastic surgeon while planning your breast reconstruction:
- What does numbness feel like?
- What is your experience with Resensation?
- Am I a candidate for Resensation?
- Based on your experience performing this procedure for other patients, when do people begin to start noticing signs of any sensory return?
- Can I speak to other patients who had the same surgery to learn about their experience?
- Can you share any published data on sensory outcomes after surgery?
If you’ve already completed your breast reconstruction:
- At this point, is it still possible for me to undergo Resensation?
- How does this surgical approach differ from those who undergo Resensation at the time of mastectomy?
If you’re not sure about nerve reconstruction:
- What are my options if I am interested in pursuing Resensation later?
- How might a delayed nerve reconstruction impact sensory recovery?
Talk About What you Feel
Navigating breast cancer treatment and risk reduction can often feel like an endless case of you don’t know what you don’t know.
Learning the basics of breast anatomy, including that of the nerves within your breast,
and why numbness can happen after a mastectomy helps you make informed decisions about your care, regardless of whether nerve reconstruction is an option.
Even if Resensation isn’t for you, sharing this knowledge can help move the needle towards better care—and better quality of life—for your community.
Frequently Asked Questions
Should I expect sensory loss after a lumpectomy or biopsy?
While nerves can be impacted during any surgical procedure, the risk of nerve injury with long-term impacts in a surgery like a lumpectomy or biopsy is low.
Can I expect sensation loss or numbness at my autologous flap donor site?
During an autologous reconstruction, a breast is reconstructed using tissue from somewhere else in your body, called a donor site, such as the belly or thighs. The nerves at the donor site may be impacted, resulting in sensory loss to that area, which may or may not return.
Can I have nerve reconstruction after a lumpectomy?
Because the risk of nerve injury during a lumpectomy is low, nerve reconstruction is most commonly performed during a breast reconstruction surgery following mastectomies only.
How does nerve reconstruction affect cancer risk?
Nerve reconstruction has not been shown to increase the risk of breast cancer compared to a mastectomy and breast reconstruction without a nerve reconstruction procedure.
However, the risk of breast cancer after any type of mastectomy is not zero, which is why it is important to view these surgeries as risk-reducing. Those who have had a mastectomy can still get breast cancer, although the risk of recurrence is very low.
During a surgery with planned nerve reconstruction, your breast surgeon will take care to remove as much breast tissue as they can and only attempt to preserve possible nerve lengths that are safe from an oncological perspective.
How long will the procedure take?
Resensation performed during breast reconstruction adds minimal additional OR time onto the procedure itself, due to ease of use with allograft nerve tissue.
Is Resensation covered by insurance?
Breast reconstruction is a covered procedure however breast nerve reconstruction, or neurotization, coverage may differ by insurer. Coverage is determined on a case-by-case basis by the insurer, which typically requires the plastic surgeon to secure pre-authorization in advance of the procedure.
Disclaimer
Individual results may vary based on patient factors and surgical approach. Resensation is a trademarked surgical nerve repair technique. Not all patients are candidates for nerve repair. The level of sensation restored following the use of the Resensation technique cannot be guaranteed. Talk to a plastic surgeon about what options may be right for you. This information is for educational purposes only and does not constitute medical advice.
The images shown are for illustrative and educational purposes only and may not be an exact representation of individual anatomy. These images illustrate immediate mastectomy with implant breast reconstruction and Resensation. Timing and other methods of reconstruction may be possible.
